J Korean Soc Transplant.  2008 Jun;22(1):58-65.

Clinical Manifestations of Mycobacterium Tuberculosis Infection after Renal Transplantation

• Sung JY
• Kim CW
• Lee HH
• Chung WK
• Park YH
• Ha J
• Kim SJ
• Yang J
• Kim YS
• Ahn C

Abstract

PURPOSE: Transplant patients under immunosuppression are susceptible to mycobacterium tuberculosis infection. We analyzed renal transplant recipients, to evaluate the risk factors, clinical characteristics, and long-term outcomes of post- transplant tuberculosis (TB).
METHODS
This study is based on the records of renal allograft recipients from October 1991 to June 2006 in two transplant centers in Korea. The demographic data, clinical manifestations, and long-term outcomes of this cohort of patients were retrospectively analyzed.
RESULTS
Total 617 patients were enrolled in this study. Eighteen cases of TB (2.92%) occurred with a mean interval from transplant to diagnosis of TB of 33.1 (range: 1~121) months. Most of post-transplant TB were pulmonary TB (including pleural) (13/18), and extrapulmonary TB occurred in 5/18. There was no difference in the prevalence of diabetes mellitus, hepatitis B or C, and immunosuppressive agents between the patients who had developed post- transplant TB and who had not. However, there was higher incidence of acute rejection in post-transplant TB group (0.9+/-1.1 vs. 0.4+/-0.6, P=0.043), and post-transplant TB group had a tendency toward more past history of TB infection (P=0.096). Thirteen patients were successfully treated, 2 patients have been under treatment and 3 patients died. The patient survival was significantly reduced by post- transplant TB in multivariate analysis (relative risk=3.355, P=0.038).
CONCLUSION
Post-transplant TB is a serious problem, which is associated with poor outcomes in renal transplant patients. Therefore, high index of suspicion is warranted to ensure early diagnosis and prompt initiation of treatment.

Keyword

Kidney transplantation; Tuberculosis; Prognosis

MeSH Terms

Cohort Studies
Diabetes Mellitus
Dietary Sucrose
Early Diagnosis
Hepatitis B
Humans
Immunosuppression
Immunosuppressive Agents
Incidence
Kidney Transplantation
Korea
Multivariate Analysis
Mycobacterium
Mycobacterium tuberculosis
Prevalence
Prognosis
Rejection (Psychology)
Retrospective Studies
Risk Factors
Transplantation, Homologous
Transplants
Tuberculosis
Dietary Sucrose
Immunosuppressive Agents